The world is on the cusp of a transformation in which data, devices, and applications will connect patients and caregivers seamlessly and securely. This transformation will empower people to maintain their health and manage chronic illness through continuous, unobtrusive monitoring. It will increase efficiency across the care continuum and enable the collection and integration of health data in meaningful ways that go beyond episodic notes collected on occasional visits to the doctor for an urgent need.
Expanding access, empowering people, increasing efficiency
Women in semi-urban and rural areas in emerging economies often die from preventable complications during childbirth. Many of these deaths could be avoided with basic imaging technology, but such technology is frequently unavailable. In Nairobi, Kenya, for example, out of a total population of 3.7 million, an estimated 5 percent (185,000) are pregnant at any given time.
However, no ultrasound services (critical in routine pregnancy monitoring and clinical diagnosis) are offered in any public primary healthcare facilities in Nairobi. Although conventional healthcare infrastructures may be lacking, many of the countries concerned have well-developed mobile phone networks. These networks are now providing a way to reach previously excluded populations.
Initiatives such as Imaging the World and Mashavu in East Africa have built innovative mHealth services based on telecommunications networks. In 2014, Philips ran a pilot project in Mobile Obstetrical Monitoring (MOM) in Indonesia. This is a prototype scalable telehealth solution for early high-risk pregnancy detection where maternal mortality is a concern. Using a mobile phone application, midwives can collect data from physical examinations and tests performed at local nursing clinics or even at the soon-to-be-mother’s home. They then send these data to obstetricians or gynecologists in a different location, who can determine whether a pregnancy might be high risk. If so, women can be referred to appropriate medical services for immediate and adequate help.
Governments, nongovernmental organizations, and large “hub-and-spoke” hospital chains are increasingly recognizing the need to move primary healthcare into the communities where people live. Lack of primary healthcare facilities is particularly acute in many parts of Africa for reasons that range from the unavailability of qualified healthcare workers to the lack of electricity, water, and basic healthcare technology.
Public-private partnerships, such as the recently established Community Life Center in Kenya, demonstrate one approach to addressing these challenges. The center has its own purified water supply, is powered by solar energy, and uses LED lighting, which provides greater security for patients and staff and enables longer opening hours. Its healthcare equipment allows for monitoring, diagnosis, and triage. Mothers-to-be can have antenatal testing, and the availability of refrigeration prevents vaccines from spoiling.
The role of ICTs
Worldwide, solutions such as tele-ICU monitoring offer an answer to another of the world’s global health challenges—the shortage of skilled staff. By implementing sophisticated algorithms that alert clinicians to changes or trends in patients’ conditions, tele-ICU monitoring allows a single specialist to monitor a large number of ICU patients, even over multiple physical locations. Hospitals benefit from a reduction in staffing requirements; patients benefit from more timely interventions and higher survival rates.
Remote diagnosis and screening are as applicable in the developed world as in emerging economies when it comes to extending access to care. They allow people living in any far-flung rural area to have access to specialist expertise that would otherwise be unavailable locally. Care providers can then offer treatment in dedicated urban centers that can handle large numbers of patients cost-effectively.
The examples presented above are just the start. As payers (both public and private health insurers) and patients continue to push for better outcomes and more personalized care at lower cost, the connected healthcare transformation will widen and deepen.
Technology built on the Internet of Things will improve the quality of life for the growing numbers of elderly people. Worldwide, older people are often excluded from active participation in society because they are not well or are no longer able to live in their own homes. By integrating a variety of ICT systems, millions of people will be enabled to stay independent for longer and to continue to contribute to economic activity. For example, an application on a tablet could manage a treatment plan to make sure seniors take their medicines on time. It could help them perform simple tasks such as taking their weight and blood pressure, or checking their heartbeat and respiration via a wearable device.
In the longer term, other devices around the home could be integrated. Home cookers might help manage the nutritional value of food, and digitally connected lamps could blink red or green to indicate when certain pills need to be taken. Data from these telecare/telehealth services will be uploaded to a dedicated center where a single healthcare professional can manage hundreds of patients simultaneously. As in tele-ICU monitoring, advanced algorithms will evaluate and prioritize the data that should be presented, so there is no information overload. The system will identify any patient whose condition gives cause for concern and alert the healthcare professional to take action.
Effective and efficient healthcare systems
Along with this empowerment, connected healthcare will enable all stakeholders in the care continuum to work together more effectively and efficiently. As data are shared seamlessly across systems, clinicians will be coordinated and informed about patients flowing through the system.
Within the decade, we expect barriers to pooling and sharing clinical information will be overcome as hospital administrators, clinicians, and researchers apply Big Data principles within and beyond the borders of their own institutions. Patients will be able to manage the confidentiality of their personal data, and aggregated data will be anonymized for use in population health management studies.
This step will offer further opportunities to extend care for individuals and entire patient populations. Smart algorithms will trawl through integrated data from hospital records and personal data, providing new insights into the impact of lifestyles, treatments, and outcomes. This learning will enable improved clinical decision support and personalized medicine based on a complete picture of factors that includes a patient’s past history, sensitivities to medications, activity levels, and nutritional intake. Genomic data will be applied to entire patient populations based on geography, ethnicity, and health status, or used to extend understanding of an individual’s genomic profile to help develop unique prevention or treatment plans.
In the long term, we may see web-based patient profiles that aggregate genomic data with other data pools to produce risk maps with mobile applications that people can download to a smartphone—with customized advice for maintaining good health.
The interoperability requirement
The fundamental requirement for change is the ability to share data from any source. This means more than software systems talking to each other, and more than data entered into a patient health record system and interacting with a tablet. The necessary change must include all data across the continuum of care, whether those data come from devices that patients carry in hospitals, from imaging systems and patient monitors, from connected technology in the home, or from wearable devices and applications that check vital signs.
Interoperability is a challenge. But, as experience from industries such as travel and banking and financial services demonstrates, the challenge is not insurmountable. With sufficient incentive, solutions will be found. And despite its fragmentary nature, foundations are being built for the exchange of health data. The Digital Imaging and Communications in Medicine (DICOM) standard has been enabling the free flow of imaging and related data since 1993. Today organizations such as the CommonWell Health Alliance (in the United States) and the international Continua Health Alliance are bringing together industry players to develop standards and interoperability for conventional and connected personal healthcare.
Compelling digital propositions for inclusive growth and better health
With relentless pressure on resources, healthcare worldwide is approaching a tipping point at which radical change must come. Connected healthcare offers a way to improve outcomes, expand access, and give millions more people the opportunity to live healthy lives—all this based on sustainable business models. Digital solutions will connect all the elements of the care continuum, empower stakeholders, and facilitate collaboration. Responsibility and incentives will shift as people are enabled to manage their own health. And as good healthcare reaches ever more people through mobile and connected technologies, it will help bring inclusive growth and better health to entire populations at a lower cost of care.
Author: Dale Wiggins is Vice President and General Manager of the Philips HealthSuite Digital Platform (HSDP)
Image: Doctor Andy Chiou (L) speaks to patient Carl Dolson in a hyperbaric chamber in Peoria, Illinois, November 26, 2013. REUTERS/Jim Young